Health

Cervical os obliteration after laser surgery in patients with amenorrhea

Article Abstract:

Laser surgery, which uses amplified light to manipulate tissues, can be used to treat women with cervical intraepithelial neoplasia (CIN), abnormal cell changes in the cervix which can develop into cancer. The laser is used to remove a cone-shaped section of diseased cervical tissue (cone biopsy), allowing the integrity of the uterus to be maintained. Complications such as infection, hemorrhage and stenosis, where scar tissue grows to narrow the cervical canal, had been reduced with the addition of the carbon dioxide laser system. The experience with laser surgery performed on nonmenstruating (amenorrheic) women in menopause is reported. Cervical laser surgery was performed on 38 nonmenstruating women in menopause and one women who was not menstruating because of a pituitary gland disorder. The cervical canal appeared to be open in all patients two weeks after laser surgery. When the cervix was examined 4 to 48 months later, the cervical canal in 18 out of 30 women available for study was blocked with tissue (cervical obliteration), including four women in whom the cervix was flush with the vaginal wall, and the canal was totally covered with scar tissue. An additional five patients had cervical stenosis. To see if there are factors contributing to the stenosis after laser surgery, physical features of nonmenstruating women were examined. It appears that blood passing through the cervical canal during menstruation prevents the blockage by scar tissue. Furthermore, before the onset of menopause mucous secretion by the glands inside the cervical canal may help to prevent stenosis. The lack of a monthly blood flow combined with the reduced mucous production during menopause may contribute to cervical stenosis. If cervical stenosis is not treated, adequate cytological cancer screening tests (PAP tests) may be difficult to perform. Techniques to prevent stenosis, such as passing a probe through the canal periodically to maintain the opening, are suggested. Preoperative high-dosed estrogen hormone therapy may help reduce stenosis in nonmenstruating women undergoing cervical laser surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Serum estradiol as an aid in the diagnosis of ectopic pregnancy

Article Abstract:

Early diagnosis of ectopic pregnancy (pregnancy located in a site other than the uterus) is important, since prompt removal of the pregnancy is essential. Blood tests that measure factors associated with ectopic pregnancy are desirable for diagnosis, and several are currently used. It is possible that determining the concentration of estradiol (E2), a female hormone, would help diagnose this condition. To evaluate this, studies were performed of 100 women with pregnancies located in their fallopian tubes; 69 women with normal pregnancies; and 36 patients who were likely to miscarry. Levels of E2, progesterone (another female hormone) and beta-human chorionic gonadotropin (beta-hCG; a hormone of pregnancy), were assayed from blood samples drawn before surgery. Results showed that the patients with ectopic pregnancies had significantly lower levels of E2 than patients in the other two groups. All ectopic pregnancy patients but one also had low levels of progesterone. Since a few of the normal pregnancies were also associated with low E2 levels, selection of an appropriate cutoff point for diagnosing ectopic pregnancy is necessary. Different cutoff points are discussed: one (700 picograms per milliliter) leads to a sensitivity (true positive results) of 100 percent and a specificity (true negatives) of 98 percent. Optimal cutoff points for the progesterone assay are also presented. It appears that using E2 and progesterone assay results together can enhance the speed and accuracy of diagnosing ectopic pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Treatment of pulmonary endometriosis with a long-acting GnRH agonist

Article Abstract:

Endometriosis is a condition in which fragments of the endometrium (the tissue that lines the uterus) implant in other regions of the body. In rare cases, pulmonary endometriosis (endometriosis in or on the lung) develops. The report is presented of such a case and its successful treatment with leuprolide acetate, a gonadotropin releasing-hormone antagonist (GnRH; a drug that stimulates hormonal release by the pituitary). The 28-year-old patient had pain on the right side of the chest, beginning at the time of her menstrual period each month. Following the development of pneumothorax (air in the chest cavity, often triggering collapse of the lung), the patient underwent surgery, which revealed the presence of endometrial tissue on the lung. Drug treatment was either ineffective (pseudopregnancy drugs) or associated with severe side effects (danazol), and the patient discontinued the medication. The chest pain continued, recurring each month in conjunction with menstruation. The patient had also been unable to become pregnant. Eventually, therapy with leuprolide acetate was started and continued for four months. The patient's symptoms vanished and, two months after drug treatment ended, she became pregnant. The chest pain did not recur after delivery of the infant. Leuprolide acetate is a possible alternative for women with pulmonary endometriosis who cannot tolerate the side effects associated with danazol (the conventional treatment for endometriosis). (Consumer Summary produced by Reliance Medical Information, Inc.)